<!--//=========================<script réaliser par :DITINI ANASS>===================         -->
{extends file="includes/skeleton.tpl"}{/extend}
{block name=title}
<title> Inscription </title>
{/block}

{block name=content}
 <div data-role="page" data-theme='b'>
 <div data-role="header" data-position="fixed" data-tap-toggle="false" data-theme='b'>
            <a href="index.php" data-ajax="false"><i class='icon-angle-left'></i></a>
            <h1>Inscription   </h1>
        </div>
	<div data-role="content">
	<br/> 
	 <form >
	 <ul data-role="listview" data-inset="true">
	 <li data-role="fieldcontain">
	 <label for="nom">Nom</label>
	 <input type="text" name="nom" required="required" id="nom" value="" data-clear-btn="true" placeholder="">
	 </li>
	 <li data-role="fieldcontain">
	 <label for="prenom">Prénom</label>
	 <input type="text" name="prenom" required="required" id="prenom" value="" data-clear-btn="true" placeholder="">
	 </li>
	 <li data-role="fieldcontain">
	 <label for="Add">Adresse</label>
	 <input type="text" name="name2" required="required" id="Add" value="" data-clear-btn="true" placeholder="">
	 </li>
	 <li data-role="fieldcontain">
	 <label for="mydate">Date Naissance</label>
	<input name="Date_dep" id="mydate" required="required"  type="text" data-role="datebox" data-options='{literal}{"mode": "calbox"}{/literal}'/>
	 </li>
	 <li data-role="fieldcontain">
	 <label for="Email">Email</label>
	 <input type="email" name="name2" required="required" id="Email" value="" data-clear-btn="true" placeholder="">
	 </li>
	 
	 <ul data-role="listview" data-inset="true">
	 <li data-role="fieldcontain">
	 <label for="ligin">Login</label>
	 <input type="text" name="login"  required="required"id="ligin" value="" data-clear-btn="true" placeholder="">
	 </li>
	 <li data-role="fieldcontain">
	 <label for="pass">Password</label>
	 <input type="password" name="pass" required="required" id="pass" value="" data-clear-btn="true" placeholder="">
	 </li>
	 <li>
	  <fieldset class="ui-grid-a">
                                <div class="ui-block-a"><button type="reset" data-theme="b">Annuler</button></div>
                                <div class="ui-block-b"><button type="submit" data-theme="b">Valider</button></div>
     
	 </fieldset>
	 </li>
	 </ul>
	 
	 </form>
	
</div>  	
 </div>
{/block}
